Relationship between Anxiety Score and Erythrocyte Sedimentation Rate (ESR) in Hemodialysis Patient


  • Rohmaningtyas Hidayah Setyaningrum Teaching Staff of Psychiatry Department, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi General Hospital, Surakarta
  • Debree Septiawan Teaching Staff of Psychiatry Department, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi General Hospital, Surakarta
  • Jhonny Prambudi Batong Residency Program of Psychiatry Department, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi General Hospital, Surakarta


Background: Anxiety in hemodialysis pati­ents often impaired quality of life. Complex interaction between Chronic Kidney Disease (CKD) and anxiety are dynamic and multifac­torial, including socio-economic, lifestyle and biological factors. Biological factors are close­ly related to anxiety in CKD including the im­mune system, inflammatory pathways of dis­orders of Hypothalamic-Pituitary-Adrenal Axis (HPA). Erythrocyte sedimentation rate (ESR) is one of the non-specific inflammatory marker that show the degree of inflammatory reaction, Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) also found as an easy and inexpensive mea­sureable marker to show the degree of inflam­mation. This study aimed to examine rela­ti­onship between anxiety and hematology in­flammation markers in hemodialysis patient.

Subjects and Method: This was an obser­vational study with a cross-sectional design. The study was conducted at Dr. Moewardi general hospital, Surakarta, Central Java. A sample of 30 hemodialysis patients was selec­ted for this study. The dependent variables were ESR, NLR, and PLR. The independent variable was anxiety. Anxiety was measured by Taylor Manifest Anxiety Scale (TMAS). Data on ESR, NLR, and PLR, were measured using an assessment from RAND Corpora­tion. The data were analyzed by a multiple linear regression.

Results:  Anxiety increased NLR and it was marginally significant (b= 0.37; 95% CI= -0.01 to 0.22; p= 0.080). Anxiety decreased ESR and it was statistically significant (b= -0.57; 95% CI= -0.02 to 0.01; p<0.001). An­xiety decreased PLR (b= -0.16; 95% CI= -0.02 to 0.01; p= 0.440) and duration of hemo­dia­lysis (b= -0.27; 95% CI= -0.03 to 0.01; p= 0.167), but they were statistically non-signi­ficant.

Conclusion: Anxiety increases NLR. Anxi­ety decreases ESR, PLR, and duration of hemo­dialysis.

Keywords: chronic kidney disease, hemo­dialysis, hematology markers, inflammation

Correspondence: Rohmaningtyas Hidayah Setyaningrum. De­partment of Psychiatry, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi General Hospital, Surakarta, Central Java. Email:

Indonesian Journal of Medicine (2020), 05(02): 109-115¬26911/theijmed.2020.05.02.03


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